Key result
Maintenance ECT safely improves psychiatric condition in a cardiac device patient despite anesthetic challenges.
Case Report (n=1)
No
Multidisciplinary management enables successful and safe maintenance electroconvulsive therapy in patients with complex medical conditions including cardiac rhythm management devices.
Supports individualized consideration of maintenance ECT with cardiac devices; leaves open prospective safety and efficacy data.
This article presents a challenging case of a 64-year-old female with treatment-resistant major depressive disorder with psychotic features and complex medical conditions, including the presence of a cardiac rhythm management device (CRMD). Despite all the complexities, she has received maintenance electroconvulsive therapy (M-ECT) over the past 4 years (56 episodes to date). Her anesthetic plan had to be tailored to her individual needs and revisited to reflect her medical conditions and perioperative complications during this period. Despite the anesthetic challenges, her psychiatric condition improved significantly, and the benefits of her M-ECT continue to outweigh the potential perioperative risks. The successful management of this patient can be attributed to the collaborative involvement and ongoing efforts of a multidisciplinary team that includes psychiatry, anesthesiology, cardiology, and theater and ward nursing personnel. We outline the ongoing challenges with the M-ECT, namely, treatment intervals, medical comorbidities, and the anesthesia management in the presence of a CRMD at a tertiary state hospital in South Africa.
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Magula et al. (2020) conducted a case report in Treatment-resistant major depressive disorder with psychotic features and a cardiac rhythm management device (n=1). Maintenance electroconvulsive therapy (M-ECT) was evaluated on Psychiatric condition improvement. Maintenance electroconvulsive therapy over 4 years significantly improved the psychiatric condition of a 64-year-old female with a cardiac rhythm management device despite anesthetic challenges.
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